By: Jean Johnson for Dental1
On an April day in Portland, Ore. the wind swept a sudden downpour sideways. Inside the large dental suite, though, hygienist Nina Cotton used an ultrasound tool to remove plaque from the teeth of her patient. “It looks you’ve been using chlorhexidine,” she said. “There’s quite a bit of staining.”
|Good dental care keeps chlorhexidine at bay:|
1. Brush two – three times a day.
2. Spend two minutes brushing each time, taking care to spend equal time in each quadrant of the mouth.
3. Floss eight to 10 swipes per surface, taking care to use a long piece of floss so that you can wrap it around the surface of the tooth and get to tartar buildup at the edges and corners.
4. Avoid snacking between meals. Even a carrot gets bacteria going that causes tooth decay.
5. Limit sugar as much as possible, particularly condensed doses like that in candy and soda.
Chlorhexidine, Chlorhexidine gluconate, Peridex. Whatever the nomenclature – formal scientific name or trade name – the antibacterial mouth rinse is all the same. In addition to having a tendency to stain the teeth, chlorhexidine tastes bitter. So even though dentists use it for a variety of reasons, the mouth rinse tends not to be a favorite with patients.
Since chlorhexidine is an antibacterial, dentists often prescribe it whenever the gum tissue is inflamed or is compromised in some way. Gingivitis, or inflammation of the gums, often sends a patient from the dentist office to the pharmacy for chlorhexidine. Once back home, it’s the rinsing routine – commonly three times a day after brushing and flossing. Swish for 30 seconds with the prophylaxis and then avoid eating or drinking for several hours.
Dentists and specialists doing implant and crown work also often rely on chlorhexidine. Hoping to reduce bacteria levels in the mouth before they perform surgical procedures on the gums, they will commonly have patients start rinsing with chlorhexidine several days before their appointments.
The chlorhexidine approach is not used across the board, however. Prosthodontist and restorative dentist, Nader M. Rassouli, D.D.S., M.S., of Portland said, “I don’t use chlorhexidine that much. The main thing when we do implant surgery is that sometimes the gum will not close back completely. That’s when we need the chlorhexidine. Otherwise, most patients don’t like the taste or the way it stains their teeth.”
Chlorhexidine especially stains the front teeth and can be particularly noticeable on fillings that have a rough surface or in areas where there are accumulations of plaque. Once the dental and surgical work that requires chlorhexidine is completed, the staining can be removed by a hygienist, albeit often in a painstaking appointment.
“It’s the walking around looking decadent that I don’t like,” said Marsha Blackwell of Portland. “I had a series of implant appointments over several months, and the dentist I went to at first used chlorhexidine across the board. Since there was no point in getting my teeth cleaned every time, I just had to endure the discoloration.”
Rassouli emphasizes that although he tends not to prescribe the rinse as standard operating procedure, it is necessary to use it in cases where surgical sites do not completely close and the danger of infection exists. More, he indicated that dentists generally evaluate the need for chlorhexidine rinses on an individual basis since a number of factors are involved in assessing the appropriateness of this prophylaxis.